Safeguarding Healthcare Workers amidst COVID-19

By Dr. Lisha Ruparel

A pandemic is a war-like situation; the enemy is an invisible virus and healthcare workers are frontline soldiers. Dr. Lisha Ruparel explores the need to ensure the safety of this army by protecting them physically, financially, emotionally and ensure their complete wellbeing.

It is rightly being said that all places of worship are shut because all Gods are in hospitals wearing white coats. Be it courage, professionalism, the need to serve others or all of the above, healthcare workers are selflessly risking their lives everyday in the battle against COVID-19.

The nature of their work puts healthcare workers like front desk staff, technicians who collect samples at an increased risk of catching any communicable disease, including COVID-19. In Mumbai, more than 200 healthcare workers have tested positive for the coronavirus. If they start to get sick in high numbers during an infectious disease outbreak, it amplifies the already high levels of strain on the healthcare system. This has resulted in hampering the operations of hospitals. At least 800-900 beds are currently out of circulation in Mumbai. Emergencies like stroke, cardiac arrest, pregnant patients, patient who need periodic treatment like dialysis, chemotherapy have been hugely impacted. That’s why it’s imperative for the professionals have access to protective equipment and for patients to be identified and isolated quickly.

How not to test Positive

Healthcare Professional Treating COVID-19 patients

Healthcare workers spend ample time up-close with patients performing high-risk activities. This makes personal protective equipment (PPE) like masks, gloves and gowns, a must for nurses and doctors to protect them against infections. In the case of the novel virus outbreak, the Center for Disease Control and Prevention (CDC) and Indian Council Of Medical Research (ICMR) recommends that healthcare workers wear N95 masks, which filter out airborne particles and tiny droplets that may have been coughed up by patients. However, the importance of viral dose is being overlooked in these discussions. Just like poison, viruses are usually more dangerous in larger amounts. Small initial exposures tend to lead to mild or asymptomatic infections, while larger doses can be lethal. Therefore, it is very important to limit the exposure of healthcare workers to patients by reducing duty hours, especially of doctors and nurses.

Dr. Hiren Ambegaokar, CEO, S. L. Raheja (A Fortis Associate) Hospital says, they have been treating COVID-19 patients as well as regular patients. “Three teams of healthcare professionals— doctors, nurses and attendants have been created. Each team is appointed in rotation of 14 days. The team attending to COVID-19 patients are provided accommodation within the hospital. Once the 14-day period elapses, the team is accommodated at a hotel for 14 days. Furthermore, strict infection control protocols and standard operating procedures need to be in place under such circumstances for the entire hospital.”

Across the world, several strategies are being followed by healthcare professionals to keep their families safe— our heroes have stayed alone in a hotel, or a separate place by themselves in fear of passing the infection to their loved ones. At times it may not be feasible, this can be worrisome with regards to bringing the infection home. Another perspective helps: staying with family can benefit mental health of healthcare workers at this stressful time. When sharing a household, social distancing, hand hygiene and personal hygiene at home is integral . If possible, giving them a separate room and if there’s more than one bathroom at home, it might be advisable to reserve one bathroom for the healthcare professional. Also, good nutrition and a healthy diet helps boost immunity.

The novel outbreak calls for novel training to ensure safety of those tacking the outbreak. All State Governments have been training doctors, nurses to identify COVID-19 patients. The health ministry website have also been releasing protocol and standard operating procedures for healthcare workers to follow on a regular basis.

Healthcare Workers Treating Non Covid-19 patients

Family physicians, consultants, dental surgeons and therapists should use requisite PPE while treating patients. It’s ideal if  patients can be tested for COVID-19 before being admitted for procedures. A gynaecologist who has been attending to patients has said that they have been asking the patients to get tested for COVID-19 before the delivery date and have been limiting the number of attendants accompanying to them. At times when a visit to a consultant is difficult, telemedicine can be encouraged whenever possible to prevent crowding at healthcare facilities. A family physician during the lockdown has been advising patients on phone, attending to only emergency cases with precautions.

Protection against Abuse

In India, there have been instances where healthcare workers have been ostracised from society, some being forced to vacate their flats; as landlords are prejudiced and fear their doctor-resident can infect the society. Health workers conducting door-to-door check-ups in contamination zones have also being attacked. Hence it become imperative that masses are sensitised and a supportive environment be created for our COVID-19 warriors.

Thankfully, the Epidemic Diseases (Amendment) Ordinance 2020 was recently passed in India to protect them during this pandemic. It not only makes these horrendous attacks on healthcare personnel a cognizable non-bailable offence, but also those on their property, including their living and working premises. It includes compensation for injury and damage to or loss of property.  The ordinance also states that omission or abetment of such acts shall be punished with imprisonment for a term of three months to five years, and with fine of INR50,000 to INR2,00,000. For causing grievous hurt, imprisonment of a term of six months to seven years with a fine of INR1,00,000 to INR5,00,000 will be levied. In addition, the offender shall also be liable to pay compensation to the victim and twice the fair market value for damage of property.

Financial Safety Net

Be it a monetary reward or a health insurance package, healthcare workers deserve in times like this. State and Central Government have been very proactive to ensure this. The Centre has proposed a INR50 lakh per person health insurance cover for frontline health workers, including sanitation staff, paramedics and nurses, ASHA workers and doctors. Haryana Government has doubled the salary of healthcare officials and workers tackling the outbreak. Delhi CM announced that families of healthcare personnel will get INR1 crore in case they die while dealing with coronavirus cases.

The Importance of Mental Wellbeing

Emotional support and words of encouragement from society and families goes a long way to boost morale of any person. In these testing times for doctors and nurses, it become even more essential. Interestingly, Dr. Amegaokar observes, “Ensuring adequate PPE has helped motivate our staff professionally as they feel safe.” A dedicated helpline has been created by the health ministry to provide psycho-social support for healthcare workers.